EP: Postoperative JET - Diagnosis

Newborn, Heterotaxy, Pulmonary atresia/TAPVR, s/p BT shunt.

DDD paced at 180 bpm. Note the change in CVP trace.


EKG: WPW syndrome

Derive the location of accessory pathway.
(Refer to another posting in this blog for a quick localization guide)


Echo features of tamponade

14 yr old with history of intermittent facial swelling (SVC syndrome). Superior mediastinal widening and cardiomegaly on CXR.

Diastolic collapse of RV free wall.

Doppler equivalent of pulsus paradoxus (?!)


General Cardiology - Preparticipation Screening for Sports

Link to 2007 recommendations from American College of Cardiology.
Barry J Maron, et al. Circulation 2007;115:1643-55

Presence of 1 or more of the 12 elements below should trigger referral for CV evaluation:
Parental verification is regarded essential for high school and middle school students.

12-element AHA recommendations for preparticipation CV screening of compettitive athletes:
Medical History:
Personal History -
1. Exertional chest pain/discomfort
2. Unexplained syncope/near-syncope (judged non-vasovagal; particular concern when related to exertion)
3. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise
4. Prior recognitiion of a heart murmur
5. Elevated BP
Family History -
6. Premature death (sudden and unexpected or otherwise) before age 50 years due to heart disease, in more than or equal to 1 relative.
7. Disability from heart disease in a close relative < 50 years
8. Specific knowledge of certain cardiac conditions in family members: HCM or DCM, LQTS or other ion channelopathies, Marfan syndrome or clinically important arrhythmias

Physical Examination:
9. Heart murmur (auscultation in supine & standing (Or val Salva) specifically for LVOTO murmur.
10. Femoral pulse
11. Features of Marfan syndrome
12. Brachial artery BP (sitting position) (preferably both arms).


EKG: RVH with strain - 7 month old

Notable points:
1) What is the significance of upright T wave in a 7-mo old baby?
2) Can you "guestimate" the RV systolic pressure from this EKG?
(Hint: RV1 is 12 mm tall)

Surgery: Indications for surgery in Ebstein's anomaly

From Mayo clinic (Mair DD et al. Surgical repair of Ebstein's anomaly:Selection of patients, early and late operative results. Circ 1985;72:II70-II76)

2) NYHA I and II, but with CT ratio 0.65 or more.
3) Significant cyanosis (80% or less; Hb 16g% or more)
4) Paradoxical embolism
5) Intractable arrhythmia (even though arrhythmia will not be altered by surgery, but it will be better tolerated after surgery)

Indications for surgery in infants with cyanosis and CHF are less clear. Should be individualized.

Also, see other posting on Neonatal Ebstein's Anomaly Management.